Managing Chronic Illness on the Clock

By Tori Mikulan 

Many firefighters are proactive in managing the health risks associated with firefighting, but some begin the job with a history of managing chronic illness. In certain instances, the seriousness of their condition may impact their eligibility for hire, or it may be monitored throughout their career.

The criteria for defining chronic disease and illness vary among entities and reporting bodies. Still, they are generally understood to be conditions that persist over an extended period (often cited as at least three months) and require ongoing management. The Centers for Disease Control and Prevention (CDC) reports that six in ten Americans have chronic illnesses. At the same time, the Canadian Chronic Disease Surveillance System (CCDSS) states that 44% of Canadians aged 20 and older have a chronic illness. These conditions can range from asthma to irritable bowel syndrome to arthritis to cancer and, as such, vary in severity and impediment.

When Walt Apple, a volunteer firefighter with Wynatskill Fire Department in New York, hears the tones drop for a call, the first thing he does is check his sugar with his Dexcom. This small wearable performs continuous glucose monitoring. He also keeps candy available in his gear. As a diabetic, Apple knows that his sugar levels are crucial to his performance, his safety, and the safety of others. 

Diabetes was once a disqualifier for hire under NFPA 1582, which sets minimal requirements as guidance for fire departments implementing occupational health programs. However,  the American Diabetes Association worked with the NFPA to change the standard concerning diabetics. Now, the standard considers many other chronic conditions, in addition to diabetes, on a case-by-case basis, looking at factors such as whether or not the condition impedes them from performing their duties.

It is also important to note that firefighters are already considered more susceptible to developing chronic illnesses such as diabetes, hypertension, obesity, etc., throughout their careers – some of the same ones that can be considered disqualifiers –  which is why preventive health measures and maintaining wellness are critical for all firefighters, especially when considering that medical emergencies cause a majority of the line of duty deaths.

Dealing with chronic illness can require a mixture of medications, treatments, routines/habits, and preventative activities. For first responders, another layer of complexity is added when considering the intensity of the work and additional hazards faced, which can exacerbate some conditions, such as high levels of physical activity causing lowered blood sugar or irritants that aggravate asthma symptoms. Additionally, we know stress can also cause flare-ups in chronic illness symptoms on top of the already detrimental effects stress can have. 

Chronic illness sufferers know that they need to be flexible in many parts of their lives because of their conditions, and some firefighters recognize the need to make sure they are ready for different scenarios. Symptoms may not always be present, but their awareness is. 

As with many health topics, there can be a stigma attached to chronic illnesses. However, ultimately, it is about everyone’s safety. A chronic illness may not automatically end a career or opportunity. Still, it can be an opportunity to help promote awareness and wellness for all of us as first responders. 

Mark Ford, a fire lieutenant for Bellevue Borough Fire Department outside of Pittsburgh, Pennsylvania, is always prepared to manage his Crohn’s disease, even when he isn’t affected by it. So he can adapt as needed. He commented, “When my flare-ups are really bad, it can cause an increased heart rate and put me at risk for severe dehydration. I make sure to drink solutions high in electrolytes, and, in the summer months, I drink a ton of water.”

Kris Maynard, now a Division Fire Chief for the Fairchild Air Force Base Fire Department in Washington state, admits that his diabetes management has had its ups and downs. When a low blood sugar incident resulted from his lax attitude, then leading to the loss of his firefighter position, his perspective towards diabetes management significantly changed. This included him adopting an insulin pump and utilizing controlled glucose monitoring. These critical changes allowed him to return to duty after two years, and in 2023, he received his promotion to Division Chief. During this time, he took his passion for helping others and diabetes to another level when he founded Glucose Revival. The company offers the innovative oral glucose necklace “Thrive,” which discreetly contains 15g of glucose gel that is easily accessible in case of a low blood sugar emergency. 

These firefighters are just a few who manage chronic illness while on the job. Many might never have difficulties or noticeable effects from their illness during their firefighting career. However, considering how many of these conditions are deemed long-term risks for firefighters, it is another reason to promote wellness in the fire service.